Wiki coding dispute between CPT book and Anesthesia code

[AudreyS]

I work for a group of Anesthesiologists and I had a case where a patient had implanted plates removed from her ribs. I coded 20680 and the code crosswalks to
01360 for anesthesia. On the EOB that the patient received the procedure description said she had work done on her femur. She called the insurance company and our office to dispute the
procedure code. In the CPT book there is NO mention of femur, only removal of deep implant. What would I do in this case and why does the anesthesia CPT code coincide with the procedure code?

 

[LisaAlonso23]

You're correct. There is no mention of the femur for 20680.

However, 01360 is the direct crosswalk for 20680 that is for a procedure on the femur, so it's not the correct anesthesia code. Look at 00470 (6 units).

When crosswalking surgery codes in the ASA Crosswalk manual, always read the code description. If the anesthesia code doesn't fit for the body area, look at the alternates listed. Then, check the Relative Value Guide for the descriptions and unit information.

Hope this helps.

 

[Samantha.Prince]

Page 58

Page 58 in the CPT for 01360 states, "Anesthesia for all open procedures on lower one-third of femur". If you look it's under subcategory "Knee and Popliteal Area" and therefore would not be appropriate to bill. I would look under "Thorax (Chest Wall and Shoulder Girdle). If there isn't an appropriate code I would suggest using the unlisted code 01999 and provider the insurance with clinical documentation.